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Attributes of a Good Microsurgeon-A Brief Counsel to the Up-and-Coming Prospects

  • Joon Pio Hong (Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine and Asian Medical Center) ;
  • Zulqarnain Masoodi (Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior) ;
  • Chieh-Han John Tzou (Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior)
  • Received : 2022.01.24
  • Accepted : 2022.08.17
  • Published : 2023.01.15

Abstract

Microsurgery, which deservedly sits on top of the reconstruction ladder, has been a boon to plastic surgery. It is because of this marvelous tool that plastic surgeons the world over have been able to tackle many reconstructive dilemmas, which were once considered to be an improbability. Microsurgery-aided revolutions have rendered a new meaning to all forms of reconstruction-whether it is postoncological, posttraumatic, or postlymphedema reconstruction. As the most advanced reconstructive medium at our disposal that has broadened the horizons of plastic surgery exponentially, it is but obvious that many budding plastic surgeons are drawn toward this subspecialty. In lieu of the aforementioned facts, it is necessary to sensitize all such aspiring surgeons about the various intricacies concerning the field of microsurgery. This article with its focus on the six desirable microsurgical attributes of "Clarity, Curiosity, Perseverance, Passion, An Open Mindset and Action," is meant to be a modest attempt on part of the authors to share their microsurgical insights, procured through their respective journeys, with budding aspirants, hoping to sensitize as well as motivate them for the challenging path that lies ahead.

Keywords

Acknowledgement

The authors wish to thank Maria Prieto Barea (www.mariaprietobarea.com) for her graphical support with the figures.

References

  1. Bible KJ (1996). King James Bible (Vol. 19). Proquest LLC.
  2. Surgery in the. 2020s: Implications of advancing technology for patients and the workforce Richard Sc Kerr. Future Healthc J 2020;7(01):46-49 https://doi.org/10.7861/fhj.2020-0001
  3. Amin K, Moscalu R, Imere A, et al. The future application of nanomedicine and biomimicry in plastic and reconstructive surgery. Nanomedicine (Lond) 2019;14(20):2679-2696 https://doi.org/10.2217/nnm-2019-0119
  4. Whitaker ISKaroo RO, Spyrou G, Fenton OM. The birth of plastic surgery: the story of nasal reconstruction from the Edwin Smith Papyrus to the twenty-first century. Plast Reconstr Surg 2007;120(01):327-336 https://doi.org/10.1097/01.prs.0000264445.76315.6d
  5. Bennett JP. Aspects of the history of plastic surgery since the 16th century. J R Soc Med 1983;76(02):152-156 https://doi.org/10.1177/014107688307600214
  6. Gbara A, Darwich K, Li L, Schmelzle R, Blake F. Long-term results of jaw reconstruction with microsurgical fibula grafts and dental implants. J Oral Maxillofac Surg 2007;65(05):1005-1009 https://doi.org/10.1016/j.joms.2006.06.294
  7. Hallock GG. The four P's that make a microsurgeon: perfectionist, pragmatist, persistent, and paranoid. J Reconstr Microsurg 2013;29(07):425-426 https://doi.org/10.1055/s-0032-1333324
  8. Hong JP. Godina Lecture at the Annual Meeting of the American Society of Reconstructive Microsurgery 2016, Jan 16 to 19, Scottsdale, AZ, USA
  9. Levitt T. What business are you in? Classic advice from Theodore Levitt. Harv Bus Rev 2006;84(10):126-137, 150
  10. Diering SL. Love Your Patients! Essential Behaviors That Enrich the Lives of Patients and Caregivers; California: Blue Dolphin Publishing, Inc. 2006
  11. Choong C, Kaye AH. Emil theodor kocher (1841-1917). J Clin Neurosci 2009-155416(12):1552-1554 https://doi.org/10.1016/j.jocn.2009.08.002
  12. Accessed October 9, 2022, at: https://www.newyorker.com/magazine/2019/10/28/the-real-nature-of-thomas-edison's-genius
  13. Fricker J. Robert Acland: Pioneer of microsurgery who forged a second career in anatomical teaching. BMJ 2016;352:i1761
  14. McGrouther DA. Robert Acland (1941-2016) innovator, microsurgeon, anatomist and teacher. J Plast Reconstr Aesthet Surg 2018;71(02):126-131 https://doi.org/10.1016/j.bjps.2017.08.035
  15. Runyon K. Microsurgery. Louisville, Kentucky: Courier Journal;1976
  16. Kleinert H. Hand Surgery in Louisville. Louisville, KY: KleinertKutz Hand Center; 2018
  17. Acland R. How the Project Began. Acland's Video Atlas of Human Anatomy. Wolters Kluwer https://aclandanatomy.com/public/About.aspx
  18. The Little Princeby Antoine de Saint-Exupery. Hardcover; New York: Harcourt, Brace & World, 1943; ISBN-13: 978-0152465032
  19. Sade RM. Transplantation at 100 years: Alexis Carrel, pioneer surgeon. Ann Thorac Surg 2005;80(06):2415-2418 https://doi.org/10.1016/j.athoracsur.2005.08.074
  20. Ernst A, Lawson H. Translated by Fripp, H. E. "A Contribution to the Theory of the Microscope and the Nature of Microscopic Vision". Proceedings of the Bristol Naturalists' Society. London, UK: Williams & Northgate; 1876:200-261
  21. Tobin G. Robert D. Acland, F.R.C.S., 1941 to 2016. Plast Reconstr Surg 2016;138(06):1376-1379 https://doi.org/10.1097/PRS.0000000000002789
  22. Opdal PM. Curiosity, Wonder and Education seen as Perspective Development. Stud Philos Educ 2001;20:331-344 https://doi.org/10.1023/A:1011851211125
  23. Marsh HW, Martin AJ, Hau K-T. (2006). A Multimethod Perspective on Self Concept Research in Educational Psychology: A Construct Validity Approach. In M. Eid & E. Diener (Eds.), Handbook of multimethod measurement in psychology (pp. 441-456). American Psychological Association
  24. Dahlin K, Taylor M, Fichman M. Today's Edisons or weekend hobbyists: technical merit and success of inventions by independent inventors. Res Policy 2004;33(08):1167-1183 https://doi.org/10.1016/j.respol.2004.06.003
  25. Gladwell M. (2008). Outliers: The Story of Success. New York: Little, Brown and Company
  26. Chase RA, Harry J. Buncke, MD July 16, 1922-May 18, 2008. J Hand Surg Am 2008;33(07):1245
  27. Lau DC (ed.) (2000). Confucius: The Analects. Columbia University Press 2008
  28. Singletary SE. A fire in our hearts: passion and the art of surgery. Ann Surg Oncol 2010;17(02):364-370 https://doi.org/10.1245/s10434-009-0732-x
  29. Fields SK, Mahan P, Tillman P, Harris J, Maxwell K, Hojat M. Measuring empathy in healthcare profession students using the Jefferson Scale of Physician Empathy: health provider-student version. J Interprof Care 2011;25(04):287-293 https://doi.org/10.3109/13561820.2011.566648
  30. Joyce KM, Joyce CW, Kelly JC, Kelly JL, Carroll SM. Levels of evidence in the plastic surgery literature: a citation analysis of the top 50'classic'papers. Arch Plast Surg 2015;42(04):411-418 https://doi.org/10.5999/aps.2015.42.4.411
  31. Shurey S, Akelina Y, Legagneux J, Malzone G, Jiga L, Ghanem AM. The rat model in microsurgery education: classical exercises and new horizons. Arch Plast Surg 2014;41(03):201-208 https://doi.org/10.5999/aps.2014.41.3.201
  32. Blondeel PN, , et al , Eds. Perforator Flaps: Anatomy, Technique, & Clinical Applications. Boca Raton, FL: CRC Press2013
  33. Hallock GG. Direct and indirect perforator flaps: the history and the controversy. Plast Reconstr Surg 2003;111(02):855-865, quiz 866 https://doi.org/10.1097/01.PRS.0000040462.38363.C7
  34. Champaneria MC, Workman AD, Gupta SC. Sushruta: father of plastic surgery. Ann Plast Surg 2014;73(01):2-7 https://doi.org/10.1097/SAP.0b013e31827ae9f5
  35. Koshima I, Yamamoto T, Narushima M, Mihara M, Iida T. Perforator flaps and supermicrosurgery. Clin Plast Surg 2010;37(04): 683-689, vii-iii https://doi.org/10.1016/j.cps.2010.06.009
  36. Jeong HH, Hong JP, Suh HS. Thin elevation: a technique for achieving thin perforator flaps. Arch Plast Surg 2018;45(04):304-313 https://doi.org/10.5999/aps.2017.01529
  37. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987;40(02):113-141 https://doi.org/10.1016/0007-1226(87)90185-8
  38. Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg 1988;81(04):561-566 https://doi.org/10.1097/00006534-198804000-00012
  39. B Hallock GG. A brief history of perforator flaps. J Xiangya Med 2018;3:4
  40. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989;42(06):645-648 https://doi.org/10.1016/0007-1226(89)90075-1
  41. Koshima I, Inagawa K, Urushibara K, Moriguchi T. Paraumbilical perforator flap without deep inferior epigastric vessels. Plast Reconstr Surg 1998;102(04):1052-1057 https://doi.org/10.1097/00006534-199809020-00020
  42. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994;32(01):32-38 https://doi.org/10.1097/00000637-199401000-00007
  43. Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 1995;96(07):1608-1614 https://doi.org/10.1097/00006534-199512000-00014
  44. Martin D, Pascal JF, Baudet J, et al. The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap. Plast Reconstr Surg 1993;92(05):867-873 https://doi.org/10.1097/00006534-199392050-00013
  45. Hong JP, Kim EK. Sole reconstruction using anterolateral thigh perforator free flaps. Plast Reconstr Surg 2007;119(01):186-193 https://doi.org/10.1097/01.prs.0000244856.98170.9c
  46. Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg 2009;123(01):230-235 https://doi.org/10.1097/PRS.0b013e3181904dc4
  47. Hong JP, Sun SH, Ben-Nakhi M. Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects. Ann Plast Surg 2013;71(04):380-383 https://doi.org/10.1097/SAP.0b013e3182503ac5
  48. Morris SF, Tang M, Almutari K, Geddes C, Yang D. The anatomic basis of perforator flaps. Clin Plast Surg 2010;37(04):553-570, xi https://doi.org/10.1016/j.cps.2010.06.006
  49. Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg 2009;123(04):132e-145e https://doi.org/10.1097/PRS.0b013e31819f2c6a
  50. Zeiger RF. Toward continuous medical education. J Gen Intern Med 2005;20(01):91-94 https://doi.org/10.1111/j.1525-1497.2004.30049.x
  51. Raskin JD. Constructivism in psychology: personal construct psychology, radical constructivism, and social constructionism. Am Commun J 2002;5(03):1-25
  52. Leung CCM, Ghanem AM, Tos P, Ionac M, Froschauer S, Myers SR. Towards a global understanding and standardisation of education and training inmicrosurgery. Arch Plast Surg 2013;40(04):304-311 https://doi.org/10.5999/aps.2013.40.4.304
  53. Creps E. Reverse Mentoring: How Young Leaders Can Transform the Church and Why We Should Let Them. Vol. 41. Hoboken, NJ: John Wiley & Sons; 2008
  54. Aasland OG, Forde R. Impact of feeling responsible for adverse events on doctors' personal and professional lives: the importance of being open to criticism from colleagues. Qual Saf Health Care 2005;14(01):13-17 https://doi.org/10.1136/qshc.2002.003657
  55. King RB. A fixed mindset leads to negative affect. Z Psychol Z Angew Psychol 2016
  56. Blondeel PN, Van Landuyt KH, Monstrey SJ, et al. The "Gent" consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003;112(05):1378-1383, quiz 1383, 1516, discussion 1384-1387 https://doi.org/10.1097/01.PRS.0000081071.83805.B6
  57. Taylor GI. The "Gent" Consensus on Perforator Flap Terminology: Preliminary Definitions; Phillip N. Blondeel, MD, Ph. D., Koen HI Van Landuyt, MD, Stan JM Monstrey, MD, Ph. D., Moustapha Hamdi, MD, Guido E. Matton, MD, Robert J. Allen, MD, Charles Dupin, MD, Axel-Mario Feller, MD, Ph. D., Isao Koshima, MD, Naci Kostakoglu, MD, and Fu-Chan Wei, MD. Plast Reconstr Surg 2003;112(05):1384-1387 https://doi.org/10.1097/01.PRS.0000081064.95573.B0
  58. Rau W, Durand A. "The academic ethic and college grades: does hard work help students to" make the grade? Sociol Educ 2000:19-38. Doi: 10.2307/2673197
  59. Thompson KR, Hochwarter WA, Mathys NJ. Stretch targets: what makes them effective? Acad Manage Perspect 1997;11(03):48-60 https://doi.org/10.5465/ame.1997.9709231663
  60. Thiel P, Masters B. Zero to One: Note on Start Ups, or How to Build the Future. Gyan Management Journal 2017;11(01):129-130
  61. Hong JP. Innovation in plastic surgery-why and how? Arch Plast Surg 2021;48(05):471-472 https://doi.org/10.5999/aps.2021.01669
  62. Hallock GG. Innovations: a dawning of a new age. Arch Plast Surg 2021;48(02):147-148 https://doi.org/10.5999/aps.2021.00255
  63. Thompson N. The surgical treatment of chronic lymphoedema of the extremities. Surg Clin North Am 1967;47(02):445-503 https://doi.org/10.1016/S0039-6109(16)38188-9
  64. Charles RH. The surgical treatment of elephantiasis. Ind Med Gaz 1901;36(03):84-99
  65. Homans J. Lymphedema of the limbs. JAMA Surg 1940;40(02):232-252 https://doi.org/10.1001/archsurg.1940.04240010072005
  66. Dellon AL, Hoopes JE. The Charles procedure for primary lymphedema. Long-term clinical results. Plast Reconstr Surg 1977;60(04):589-595 https://doi.org/10.1097/00006534-197710000-00015
  67. Tinhofer IE, Steinbacher J, Tzou CJ. Mikrochirurgische Therapieoptionen beim Lymphodem. Phlebologie 2021;50(02):141-146 https://doi.org/10.1055/a-1375-6891
  68. Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000;16(06):437-442 https://doi.org/10.1055/s-2006-947150
  69. Hong JPJ, Song S, Suh HSP. Supermicrosurgery: principles and applications. J Surg Oncol 2018;118(05):832-839 https://doi.org/10.1002/jso.25243
  70. Tzou CJ, Steinbacher J, Czedik-Eysenberg M, et al. Institutionalization of reconstructive lymphedema surgery in Austria-Single center experience. J Surg Oncol 2020;121(01):91-99 https://doi.org/10.1002/jso.25740
  71. Mackenzie EL, Larson JD, Poore SO. Plastic surgery and specialty creep: an analysis of publication trends. Arch Plast Surg 2021;48(06):651-659 https://doi.org/10.5999/aps.2021.00745
  72. Neligan PC. The future of plastic surgery. Arch Plast Surg 2022;49(01):1-2  https://doi.org/10.5999/aps.2021.02278